Republicans Are Playing Pre-Existing Conditions Kabuki


The topic of the day is pre-existing conditions: namely the fact that the latest version of the Republican health care bill guts Obamacare’s guarantee that insurers have to insure all customers at the same price. It’s what everyone is talking about.

Wait. Did I say “gut”? National Review editor Rich Lowry disagrees:

The Phrase ‘Pre-Existing Conditions’ Leads to the Suspension of All Thought

The moderates are abandoning the health-care bill largely because it makes it possible for states to get a waiver from the pre-existing condition regulation in Obamacare. This is being distorted as an abolition of that regulation, with the moderates either contributing to the misunderstanding or being carried along by it. Ramesh ably explained the other day why this isn’t true. But apparently all you have to do to win the debate over Obamacare repeal is say “pre-existing condition,” regardless of whether you have any idea what you are talking about. I don’t think anyone wants to go back to the pre-Obamacare status quo on this issue, but….

The Ramesh Ponnuru post that Lowry links to is worth a read, though I think Ponnuru downplays the real effect of the waiver clause. I’m also pretty sure that, actually, lots of people would like to go back to the pre-Obamacare status quo. That’s especially true of people who really understand how health insurance works. After all, once you accept that people with pre-existing conditions should be allowed to buy health coverage at the same price as everyone else, you pretty much have to accept both the individual mandate and the federal subsidies in Obamacare. You can call them “continuous coverage” and “tax credits” if you want, but they’re the same thing.

But for a moment let’s put that all aside, because there’s a more fundamental question here. Like it or not, Obamacare does protect people with pre-existing conditions. Insurers have to accept anyone who applies and they have to charge them the same premiums as anyone else. This has no effect on the federal budget, which means it can’t be repealed in a reconciliation bill.1 Unless someone kidnaps the Senate parliamentarian’s dog and threatens to kill poor Fido unless they get a favorable ruling, any attempt to repeal Obamacare’s pre-existing conditions ban will be tossed out of the bill. And keep in mind that Obamacare’s ban is absolute. As long as it’s around, insurers have to take all comers at the same price no matter what any other legislation says.

So all the limitations regarding pre-existing conditions in the Republican bill are just kabuki. What’s the point?

1Oh sure, you can gin up a case where it has some small effect. But that doesn’t work. Reconciliation bills are limited to things that directly affect the budget. Incidental effects don’t count.